Comparison of Blood-Sparing Efficacy of ε-Aminocaproic Acid and Tranexamic Acid in Newborns Undergoing Cardiac Surgery

Abstract

Background: ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are used for antifibrinolytic therapy in neonates undergoing cardiac surgery, although data directly comparing their blood-sparing efficacy are not yet available. We compared two consecutive cohorts of neonates for the effect of these two medications on perioperative blood loss and allogeneic transfusions. Material and Methods: Data from the EACA group (n = 77) were collected over a 12-month period; data from the tranexamic acid group (n = 28) were collected over a 5-month period. Blood loss, rate of reoperation due to bleeding, and transfusion requirements were measured. Results: There was no significant difference in blood loss at 6 hours (EACA 24 [17–30] mL/kg [median (interquartile range)] vs. TXA 20 [11–34] mL/kg, p = 0.491), at 12 hours (EACA 31 [22–38] mL/kg vs. TXA 27 [19–43] ml/kg, p = 0.496) or at 24 hours postoperatively (EACA 41 [31–47] mL/kg vs. TXA 39 [27–60] mL/kg; p = 0.625) or transfusion of blood products. Conclusions: ε-Aminocaproic acid and tranexamic acid are equally effective with respect to perioperative blood loss and transfusion requirements in newborns undergoing cardiac surgery.

Key words

blood transfusion (includes blood typing) - congenital heart disease - CHD - neonate - cardiopulmonary bypass - CPB

References

• 1 Koch C G, Li L, Duncan A I et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting.  Crit Care Med. 2006;  34 1608-1616
• 2 Kipps A K, Wypij D, Thiagarajan R R, Bacha E A, Newburger J W. Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.  Pediatr Crit Care Med. Epub 2010 May 6 DOI: PMID 20453699
• 3 Eaton M P. Antifibrinolytic therapy in surgery for congenital heart disease.  Anesth Analg. 2008;  106 1087-1100
• 4 Chauhan S, Bisoi A, Modi R, Gharde P, Rajesh M R. Tranexamic acid in paediatric cardiac surgery.  Indian J Med Res. 2003;  118 86-89
• 5 Chauhan S, Das S N, Bisoi A, Kale S, Kiran U. Comparison of epsilon aminocaproic acid and tranexamic acid in pediatric cardiac surgery.  J Cardiothorac Vasc Anesth. 2004;  18 141-143
• 6 Chauhan S, Kumar B A, Rao B H et al. Efficacy of aprotinin, epsilon aminocaproic acid, or combination in cyanotic heart disease.  Ann Thorac Surg. 2000;  70 1308-1312
• 7 Rao B H, Saxena N, Chauhan S, Bisoi A K, Venugopal P. Epsilon aminocaproic acid in paediatric cardiac surgery to reduce postoperative blood loss.  Indian J Med Res. 2000;  111 57-61
• 8 Reid R W, Zimmerman A A, Laussen P C et al. The efficacy of tranexamic acid versus placebo in decreasing blood loss in pediatric patients undergoing repeat cardiac surgery.  Anesth Analg. 1997;  84 990-996
• 9 Levin E, Wu J, Devine D V et al. Hemostatic parameters and platelet activation marker expression in cyanotic and acyanotic pediatric patients undergoing cardiac surgery in the presence of tranexamic acid.  Thromb Haemost. 2000;  83 54-59
• 10 Zonis Z, Seear M, Reichert C, Sett S, Allen C. The effect of preoperative tranexamic acid on blood loss after cardiac operations in children.  J Thorac Cardiovasc Surg. 1996;  111 982-987
• 11 Bulutcu F S, Ozbek U, Polat B et al. Which may be effective to reduce blood loss after cardiac operations in cyanotic children: tranexamic acid, aprotinin or a combination?.  Paediatr Anaesth. 2005;  15 41-46
• 12 Ririe D G, James R L, O'Brien J J et al. The pharmacokinetics of epsilon-aminocaproic acid in children undergoing surgical repair of congenital heart defects.  Anesth Analg. 2002;  94 44-49
• 13 Henry D, Carless P, Fergusson D, Laupacis A. The safety of aprotinin and lysine-derived antifibrinolytic drugs in cardiac surgery: a meta-analysis.  CMAJ. 2009;  180 183-193
• 14 Kern F H, Morana N J, Sears J J, Hickey P R. Coagulation defects in neonates during cardiopulmonary bypass.  Ann Thorac Surg. 1992;  54 541-546
• 15 Paparella D, Brister S J, Buchanan M R. Coagulation disorders of cardiopulmonary bypass: a review.  Intensive Care Med. 2004;  30 1873-1881
• 16 Kuhle S, Male C, Mitchell L. Developmental hemostasis: pro- and anticoagulant systems during childhood.  Semin Thromb Hemost. 2003;  29 329-338
• 17 Albisetti M. The fibrinolytic system in children.  Semin Thromb Hemost. 2003;  29 339-348
• 18 Goldschmidt B, Sarkadi B, Gardos G, Matlary A. Platelet production and survival in cyanotic congenital heart disease.  Scand J Haematol. 1974;  13 110-115
• 19 Gill J C, Wilson A D, Endres-Brooks J, Montgomery R R. Loss of the largest von Willebrand factor multimers from the plasma of patients with congenital cardiac defects.  Blood. 1986;  67 758-761
• 20 McClure P D, Izsak J. The use of epsilon-aminocaproic acid to reduce bleeding during cardiac bypass in children with congenital heart disease.  Anesthesiology. 1974;  40 604-608